Organization
COLORADO RETINA ASSOCIATES, PLLC
Active
Parent organization
COLORADO RETINA ASSOCIATES, PLLC
Other names
Colorado Retina Associates, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLORADO RETINA ASSOCIATES, PLLC
Authorized official
KYLIE WAKASUGI (CREDENTIALING SPECIALIST)
(303) 261-1600
Entity
Organization
Contact information
Practice address
3401 QUEBEC ST # 105, DENVER, CO 80207-2322
(303) 261-1600
(303) 261-1601
Mailing address
PO BOX 17949, DENVER, CO 80217-0949
(303) 261-1600
(303) 261-1600
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C807051
—
CO
Enumeration date
06/21/2021
Last updated
11/16/2021
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